2020_ACH_FORM.pdf

PDF 54 KB Posted

Attached to
ANNUAL FIRE EXTINGUISHER INSPECTION & MAINTENANCE SERVICES/EQUIPMENT
Solicitation number
25-S-042
Issued by
District of Columbia

About this file

This is an Authorization Agreement for Automatic Deposits (ACH Credits) form issued by the Washington Convention and Sports Authority (WCSA), also known as Events DC, located in the District of Columbia. The form authorizes WCSA to initiate credit entries and, if necessary, debit entries and adjustments to a designated checking or savings account held at a specified depository. The agreement remains in effect until WCSA receives written termination notification from the account holder, providing the company and depository reasonable time to process the request.

The form requires completion of standard banking information including the depository name, branch location, transit/ABA number, and account number. The authorized individual must provide their name, title, email address, phone number, and signature, with an option to designate a copy recipient for ACH notifications. A voided check must be attached to verify account details. This document is typically used in conjunction with vendor payment processing for contracted services, such as the Annual Fire Extinguisher Inspection & Maintenance Services solicitation for District of Columbia Department of Small, Local, and Business Development certified business enterprises.

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Text version

AUTHORIZATION AGREEMENT FOR AUTOMATIC DEPOSITS (ACH CREDITS)

COMPANY NAME: _____________________________________

EIN or Tax ID of the Business: ________________________________________

I (we) hereby authorize Washington Convention and Sports Authority (WCSA), hereinafter called COMPANY, to initiate credit entries and to initiate, if necessary, debit entries and adjustments for any credit entries in error to my (our) Checking Savings account (select one) indicated below and the depository named below, hereinafter called DEPOSITORY, to credit and/or debit the same to such account.

DEPOSITORY

NAME BRANCH

CITY STATE ZIP

TRANSIT/ABA NO. ACCOUNT NO.

This authority is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.

NAME: __ TITLE: _______________________

Email for ACH Notification: ______________________ cc: ___________________________

PHONE #: __________________________________ DATE: ________________________

SIGNATURE:

*** ATTACH A VOIDED CHECK ***

File details come from the government source that posted it. Updated .